员工参与实施初级保健价值基础支付计划增加了门诊护理的利用率:混合方法研究
Ritu Ghosal1, Natalie Royal Kenton2, Megan Holtorf1
1Center for Outcomes Research & Education, Portland, OR, USA.
概括
初级保健价值支付 (VBP) 模式改善了患者获得初级和专科护理的机会. 员工参与VBP倡议是提高护理提供和患者结果的关键.
科学领域:
- 医疗保健服务研究 医疗服务研究
- 卫生经济学 卫生经济学
- 初级医疗保健医学 一级医疗保健医学
背景情况:
- 基于价值的支付 (VBP) 模式在初级保健中越来越多地被采用,以提高医疗保健的质量和效率.
- 了解这些模型对患者医疗保健利用的影响以及实施这些模型的诊所的经验至关重要.
研究的目的:
- 检查初级保健VBP模型 (PCPM) 对患者医疗保健利用的影响.
- 捕捉参与PCPM模型的诊所的实施经验.
主要方法:
- 融合平行混合方法研究设计.
- 定量分析:差异模型比较PCPM和非PCPM诊所之间的门诊利用率,使用俄勒冈州所有付款人所有索赔 (APAC) 数据 (N=139,402).
- 定性分析:与7家PCPM诊所的12名运营/行政人员进行半结构面试.
主要成果:
- 与对照组相比,PCPM患者与初级护理 (增加4.2个百分点) 和专科护理 (增加1.1个百分点) 的联系显著增加.
- 在使用者中,每1000个成员月的初级保健访问增加了136.9,每1000个成员月的专科护理访问增加了32.1个.
- 定性调查结果强调了员工沟通,参与工作流程创建以及访问程序数据的重要性,以成功实施和改善患者护理.
结论:
- PCPM模型导致了对初级和专科护理的使用率增加.
- 成功实施VBP依赖于吸引护理团队人员,并证明VBP举措与改善患者结果之间的直接联系.
- 通过明确与患者护理福利的联系来激励员工,可以提高参与度并改善患者与服务的整体联系.
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